Healthcare Provider Details

I. General information

NPI: 1962533679
Provider Name (Legal Business Name): OBI N NWASOKWA, MD, PHD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19719 HILLSIDE AVE
HOLLIS NY
11423-2126
US

IV. Provider business mailing address

12 LINDEN BLVD
GREAT NECK NY
11021-1142
US

V. Phone/Fax

Practice location:
  • Phone: 718-479-7808
  • Fax: 718-479-7491
Mailing address:
  • Phone: 718-479-7808
  • Fax: 718-479-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number169721
License Number StateNY

VIII. Authorized Official

Name: OBI N NWASOKWA
Title or Position: PHYSICIAN
Credential: MD
Phone: 718-479-7808